BMC Nephrol. 2019;20(1):354.

Possible beneficial association between renin-angiotensin-aldosterone-system blockade usage and graft prognosis in allograft IgA nephropathy: a retrospective cohort study.

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제1저자 박세훈, 백충희 · 교신저자 이하정

PMID 31510954 PMC6737644 DOI 10.1186/s12882-019-1537-1 IF 2.9 신장내과

소속 (11)

Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
Department of Pathology, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. mdhjlee@gmail.com.
Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea. mdhjlee@gmail.com.

Abstract

BACKGROUND Although immunoglobulin A nephropathy (IgAN) is associated with an increased risk of renal allograft failure, evidences for its treatment, including renin-angiotensin-aldosterone system blockade (RAASB) usage, remain limited.

METHODS In this bi-center retrospective cohort study, we included patients who were recently diagnosed with IgAN through allograft biopsies. We identified their 6-month antihypertensive medication prescriptions and investigated the association between the medication types, albuminuria changes, and risk of 5-year death-censored-graft-failure (DCGF). The mixed effect model and cox regression analysis were used.

RESULTS A total of 464 allograft IgAN patients were included: 272, 38, 33, and 121 patients in the no antihypertensive medication, single agent RAASB, single agent beta blocker (BB)/calcium channel blocker (CCB), and combination therapy groups, respectively. High-degree albuminuria after 6 months of allograft IgAN diagnosis was an important prognostic parameter and a partial mediator for the association between the subgroups and 5-year DCGF. The usage of single RAASB was associated with decrement of albuminuria from allograft IgAN diagnosis (P for interaction = 0.03). The single BB/CCB group demonstrated significantly worse prognosis than the single RAASB group (adjusted hazard ratio, 2.76 [1.09-6.98]; P = 0.03).

CONCLUSIONS In conclusion, RAASB may be beneficial for graft prognosis in early allograft IgAN patients who require single antihypertensive medication therapy, by means of reducing albuminuria. Further investigation of treatment strategy in allograft IgAN is warranted.

Keywords

ACE inhibitorsAllograftAngiotensin receptor blockadeIgA nephropathyProteinuriaRenin-angiotensin-aldosterone systemTransplantation

Figures

**Fig. 2** Kaplan-Meier survival curve showing death-censored graft failure according to the prescribed antihypertensive medication categories. The x-axis indicates time from the diagnosis of allograft IgAN while the y-axis indicates cumulative survival

그림 출처: PubMed Central 공개 논문 (PMC6737644)

Conflict of interest statement

The authors declare that they have no competing interests.

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